The Glycemic Indices in Dialysis Evaluation (GIDE) study: Comparative measures of glycemic control in diabetic dialysis patients

The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end‐stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra‐patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra‐patient variability over a 3‐month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.     

腹腔镜与开放手术治疗子宫恶性肿瘤的临床比较与分析

目的比较腹腔镜与开放手术治疗子宫恶性肿瘤的临床疗效,探讨腹腔镜治疗子宫恶性肿瘤的手术技巧和并发症的防治。方法选择60例子宫恶性肿瘤患者行腹腔镜（腹腔镜组,30例）和开放（开放组,30例）根治性全子宫切除术（或改良根治性全子宫切除术）及盆腔淋巴结清扫术。观察2组患者手术时间、术中出血量、切除盆腔淋巴结数量、术后肛门排气时间、术后下床活动时间、住院时间和并发症等情况。结果腹腔镜组手术时间、术中切除盆腔淋巴结和并发症的发生与开放组无差异。腹腔镜组术中出血量显著少于开放组,术后肛门排气时间早于开放组,术后住院时间短于开放组,差异均有统计学意义（均P〈0.05）。结论腹腔镜下根治性全子宫切除术及盆腔淋巴结清扫术,能完全达到开放手术的要求,手术创伤小、恢复快,临床疗效明显优于开放手术,是一种治疗子宫恶性肿瘤的理想方法。     

脂质组学在糖尿病及其并发症早期诊断和治疗中的作用

糖尿病早期无任何症状,或仅伴有轻度乏力、不适、口渴等不明显症状,但糖尿病的诊断标准仅血糖一项,较为单一,并且早期病变期的患者血糖指数变化并不明显,往往在发生严重并发症时才察觉。脂质组学的发展,能够通过对糖尿病患者和健康人群的血浆脂质组分的检测、比较,建立更为全面、准确的糖尿病病前诊断和病后治疗效果的评价标准。综述了脂质组学在糖尿病及其并发症诊断和治疗中的作用,总结了糖尿病诊断过程中的主要脂质标志物,探究了膳食结构和药物对糖尿病患者血浆中脂质标志物种类和数量变化的影响。     

The Role of Kisspeptin in the Pathogenesis of Pregnancy Complications: A Narrative Review

Kisspeptins are the family of neuropeptide products of the KISS-1 gene that exert the biological action by binding with the G-protein coupled receptor 54 (GPR54), also known as the KISS-1 receptor. The kisspeptin level dramatically increases during pregnancy, and the placenta is supposed to be its primary source. The role of kisspeptin has already been widely studied in hypogonadotropic hypogonadism, fertility, puberty disorders, and insulin resistance-related conditions, including type 2 diabetes mellitus, polycystic ovary syndrome, and obesity. Gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth, fetal growth restriction (FGR), or spontaneous abortion affected 2 to 20% of pregnancies worldwide. Their occurrence is associated with numerous short and long-term consequences for mothers and newborns; hence, novel, non-invasive predictors of their development are intensively investigated. The study aims to present a comprehensive review emphasizing the role of kisspeptin in the most common pregnancy-related disorders and neonatal outcomes. The decreased level of kisspeptin is observed in women with GDM, FGR, and a high risk of spontaneous abortion. Nevertheless, there are still many inconsistencies in kisspeptin concentration in pregnancies with preterm birth or PE. Further research is needed to determine the usefulness of kisspeptin as an early marker of gestational and neonatal complications.